The Lead Episode 123: A Discussion of Re-Ablation of Atrial Fibrillation Targeting Electrogram Dispersion –The RESTART Trial, Live at HRX 2025-The Lead Episode 123: A Discussion of Re-Ablation of Atrial Fibrillation Targeting Electrogram Dispersion –The RESTART Trial, Live at HRX (Bonus Video)

The Lead Episode 123: A Discussion of Re-Ablation of Atrial Fibrillation Targeting Electrogram Dispersion –The RESTART Trial, Live at HRX (Bonus Video)

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Video Transcription

Video Summary

Dr. Paul Zai hosts a discussion at HRX 2025 Live on the RESTART trial, a prospective, multi-center study investigating redo ablation in atrial fibrillation (AF) patients with isolated pulmonary veins confirmed disconnected during the procedure. The trial enrolled 213 patients, primarily in the U.S., focusing on those with prior ablations and symptomatic AF recurrences. Using Volta Medical’s AI-driven mapping system to detect electrogram dispersion, the study showed 85% freedom from AF and significant improvement in quality of life. However, limitations include its single-arm design, selective patient population excluding those with reconnected veins or non-inducible AF, and variable rhythm monitoring. Panelists debated implications for clinical practice, emphasizing the need for personalized mapping-based approaches over empirical ablation strategies like posterior wall isolation, especially given potential benefits and risks. The integration of AI enhances rapid electrogram analysis to guide targeted ablation. Future directions include randomized trials comparing tailored versus anatomic ablation and improving procedural efficiency through technology integration and catheter versatility.

Keywords

RESTART trial

atrial fibrillation

redo ablation

AI-driven mapping

electrogram dispersion